Family physicians can tell story after story to illustrate why primary care is the most important part of a well-designed health care system, and thanks to the three-year Health is Primary campaign(healthisprimary.org) that Family Medicine for America's Health(fmahealth.org) (FMAHealth) launched in 2015, the rest of the country is hearing plenty of those examples.
During the Denver stop on the Health is Primary City Tour, panelist Luke Casias, M.D., describes the successes of the Fit Family Challenge, a program designed to fight childhood obesity, including a significant decrease in participants' body mass index.
The campaign's message is aimed at patients, payers, policymakers and purchasers. It is built around the stories of physicians who have found new ways of helping their patients by employing alternative care and payment models, successful advocacy and thoughtful partnerships. Inherent in these stories are innovations that physicians can apply in their own practices, ranging from ideas for improving small-group visits to local political tactics that may reduce smoking rates.
In panel discussions led by documentary filmmaker and reporter T.R. Reid, Health is Primary has been making the case that a strong primary care system will let family physicians deliver on the triple aim of better health, better care delivery and lower costs, all while adding to physician satisfaction. The national tour began in Seattle in March and then moved on to Raleigh, N.C.; Washington, D.C.; Chicago; Denver and Detroit. The campaign will continue across the country with various events over the next two years.
It's critical that the entire country gets the message.
"Our nation is facing a health crisis. We have the most expensive health care system in the world, yet we rank almost last in industrial countries in the health of our people," said FMAHealth Board Chair Glen Stream, M.D., M.B.I., during the Seattle event. "We believe the solution to many, if not all, of our health care problems can be found in primary care."
Seattle: Finding Motivation, Expanding the Pipeline
The campaign kickoff in Seattle featured physicians in private practice and academia who shared stories of rewarding group visits, new payment options and expansion of the family medicine pipeline.
Devin Sawyer, M.D., director of the residency program at Providence St. Peter Family Medicine in Olympia, Wash., described the sort of group visits he's found work especially well for diabetes management: meeting with three patients for an hour to discuss life with the disease and create action plans. A medical assistant prepares everyone for the visit by scheduling lab work and making sure Sawyer has the data he needs, and then transcribes what takes place so Sawyer can focus on the patients.
It's not unusual for these patients to exchange phone numbers so they can motivate each other between appointments.
Other primary care physicians used the Health is Primary platform to share ideas for ensuring patients have access to the care they need. To facilitate that access in rural areas, panelist Thomas Norris, M.D., said the University of Washington Department of Family Medicine, where he is chair, introduced the TRUST (Targeted Rural Underserved Training) program(depts.washington.edu), which admits students who grew up in rural areas using a separate admission process.
Each student is assigned to a small town, where a local physician and his or her patients serve as the student's learning laboratory during medical school. This helps the students gain a deep understanding of rural demographics, disease patterns, chronic disease management and how to work with other local professionals.
Raleigh: Innovating in Community, State
During a Health is Primary city tour stop in Raleigh, N.C., in April, a crowd that included policymakers and reporters learned how innovative solutions from family physicians can help solve America's health care problems.
Annette DuBard, M.D., M.P.H., (right) discusses a patient's care instructions with a medical assistant.
They heard how Thomas White, M.D., then the North Carolina AFP president, noticed that his town's firefighters had an unusually high mortality rate because their roles in the community contributed to an elevated risk for cardiovascular disease. They suffered from stress, White said, as well as poor diet because of their unpredictable jobs. He helped keep his community safe by examining other risk factors for the firefighters and ordering lipid screenings and blood sugar tests.
Moving to a state-level perspective, the audience learned what Community Care of North Carolina (CCNC) did about the fact that aged, blind and disabled patients -- only 30 percent of the state's Medicaid population -- generated about 70 percent of the program's health care costs.
CNCC created a population-based transitional care initiative(www.communitycarenc.org) that helps these patients when they leave the hospital. It unites care managers, hospitals, social service agencies and other community providers to help patients who suddenly have new medication regimens and diagnoses move back to the care of their primary care physicians. Annette DuBard, M.D., M.P.H., CCNC's senior VP for informatics and evaluation, said the program prevents an average of one readmission during the year for every six patients it supports.
Washington, D.C.: Educating Legislators
The Health is Primary campaign made a brief stop on Capitol Hill in May to speak directly to those who are shaping America's health care system through legislation and regulation. The message was clear: Payment must be reformed to support the care our nation needs.
Panelist Thomas Warcup, D.O., medical director for Carolina Advanced Health in Chapel Hill, N.C., pointed out that although some visits could be better conducted by telemedicine than face to face, insurers who are reluctant to pay for the service force patients to make unnecessary office visits.
Panelist Carolyn Lopez, M.D., president of the Chicago Board of Health and a former speaker of the AAFP Congress of Delegates, gave policymakers a clear example of how they can help primary care physicians improve the health of their communities. After aldermen in her city increased the price of cigarettes to $12 or more per pack by raising the local tax, she said, the smoking rate fell from 13.6 percent to 10.7 percent among high-school students, and from 22 percent to 17 percent among adults.
Chicago: Caring for Patients at Home
In May, Health is Primary brought the city tour to Chicago and highlighted the achievements of family physician Thomas Cornwell, M.D.
Thomas Cornwell, M.D., visits patient Josh Bowler at the Bowler family home. Josh, a quadriplegic patient, has been in Cornwell's care for nine years.
More than 20 years ago, Cornwell helped launch a home-based primary care model in the Chicago area and has since made nearly 32,000 house calls to more than 4,000 patients. All of his patients have serious mobility issues that make leaving the house for an office visit difficult.
"You just can't get more patient-centered than when your patients can't leave the home and you show them so much dignity and respect by bringing wonderful care to them," said Cornwell.
Cornwell said this is the perfect time for the resurgence of house calls, citing an aging population, Medicare and Medicaid fiscal issues, the attention to reducing hospital readmissions and the shift from volume-based to value-based payment. Shared savings programs and similar incentives, he said, will demonstrate the value of caring for patients in their homes.
Others see the value, too. In 2013, Cornwell received $15 million in private funding to help spread the house care model.
Denver: Including Family and Workplace
When the Health is Primary campaign hit Denver in October, it put a spotlight on new approaches that recast health care for the contexts that most people spend their lives in -- family and the workplace.
Colorado family physicians described the Fit Family Challenge program(www.coloradoafp.org) they created to address the rise in childhood obesity, especially among rural and underserved populations. The program encourages children ages 6-12 whose body mass index is in the 85th percentile or higher to set goals with their primary care physician and then arranges monthly meetings with the whole family.
Family physician Clint Flanagan, M.D., owner of the first direct primary care (DPC) business in Colorado -- Nextera Healthcare -- has been on a collision course with the status quo since he hung out his DPC shingle in 2011.
Clint Flanagan, M.D, shared details about the professional satisfaction and health benefits he found when he launched Nextera Healthcare, the first direct primary care practice in Colorado, in 2011.
The model allows patients and employer groups to pay for their health care directly for less than a monthly phone bill and receive close personal attention. Not only does Flanagan encourage patients to call or text him with any health question, he also makes informal visits to talk with employees of his clients. That usually means a lunchtime group chat at a business, but at Left Hand Brewing Co., he holds the meetings in the tasting room at happy hour. In either case, the point is to put people at ease for a discussion about health.
Michigan: Rethinking Training
During the final 2015 city tour stop in Detroit in October, panelist Allan Wilke, M.D., told listeners how he has incorporated innovative ideas into training at the Western Michigan University Homer Stryker M.D. School of Medicine Family and Community Medicine Department, where he is chair as well as director of its family medicine residency program.
Wilke wanted to give his community access to family physicians and give residents an opportunity to treat a diverse and challenging mix of patients. He found a path to both goals by moving the family medicine program's clinical operation to a newly renovated federally qualified health center.
The new program also is intended to attract residents who want to work with underserved populations, and who perhaps will stay at the health center after they graduate. "It's that whole notion of 'Train residents where you want them to work,'" Wilke said.
The Health is Primary campaign is full of stories of specific innovations that help specific groups of patients, but its overall message is much broader: America must give better support to primary care, for the good of us all.
Reid -- who as moderator helped physicians tell their stories at Health is Primary events around the country -- wrote in a guest editorial for AAFP News in October that there are signs this message is getting through.
"More and more, health policy experts, patients and those who pay the bills are coming to realize that an emphasis on primary care is an essential requirement for better health outcomes at lower cost," Reid wrote. "Our seminars around the country ... are helping to emphasize a key point: Primary care doctors love their work; it's time for America to love them back."
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